The use of surgical simulation has increased over the past two decades (Stefanidis D., Sevdalis N., Paige J., Zevin B., Aggarwal R., Grantcharov T., et al., “Simulation in surgery: what's needed next?” Annals of Surgery 2015; 261(5):846-53), likely due to an increased demand for patient safety (Gerben E., Breimer V. B., Thomas Looi, James Drake, “Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy,” J. Neuro. Pediat. 2015; 15:82-8), and declining trainee operative case-loads (Breimer G. E., Bodani V., Looi T., Drake J. M., “Design and evaluation of a new synthetic brain simulator for endoscopic third ventriculostomy,” J. Neuro. Pediat. 2015; 15(1):82-8; Sheckter C. C., Kane J. T., Minneti M., Garner W., Sullivan M., Talving P., et al., “Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience,” J. Surg. Educ. 2013; 70(4):466-74). In addition, there has tended to be a shift of the apprenticeship model of learning to include more objective competency-based metrics (Stefanidis D., Sevdalis N., Paige J., Zevin B., Aggarwal R., Grantcharov T., et al., “Simulation in surgery: what's needed next?” Annals of Surgery 2015; 261(5):846-53; Rosen J. M., Long S. A., McGrath D. M., Greer S. E., “Simulation in plastic surgery training and education: the path forward,” Plastic and Reconstructive Surgery 2009; 123(2):729-38; discussion 39-40). This has been complemented by studies indicating that surgical simulation tends to translate into improved operating room performance (Palter V. N., Grantcharov T. P., “Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: a randomized controlled trial,” Annals of Surgery 2014; 259(3):443-8; Palter V. N., Grantcharov T. P., “Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial,” Annals of Surgery 2012; 256(1):25-32; Crochet P., Aggarwal R., Dubb S. S., Ziprin P., Rajaretnam N., Grantcharov T., et al., “Deliberate practice on a virtual reality laparoscopic simulator enhances the quality of surgical technical skills,” Annals of Surgery 2011; 253(6):1216-22; Barsuk J. H., McGaghie W. C., Cohen E. R., O'Leary K. J., Wayne D. B., “Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit,” Critical Care Medicine 2009; 37(10):2697-701; Barsuk J. H., McGaghie W. C., Cohen E. R., Balachandran J. S., Wayne D. B., “Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit,” Journal of Hospital Medicine 2009; 4(7):397-403).
Simulation in plastic surgery has included both physical and computer models (Matthes A. G., Perin L. F., Rancati A., da Fonseca L., Lyra M., “Mastotrainer: new training project for breast aesthetic and reconstructive surgery,” Plastic and Reconstructive Surgery 2012; 130(3):502e-4e; Long S. A., Stern, Carrie Scharf, Napier, Zachary, “Educational Efficacy of a Procedural Surgical Simulator in Plastic Surgery: A Phase I Multicenter Study,” Plastic and Reconstructive Surgery 2013; 132(45-1):13; Juma A. M. V., Gunasekar; Martin, John A., “see-through in vitro tendon repair model,” Plastic and Reconstructive Surgery 2004; 113(3):1097-8; Wanzel K. R., Matsumoto E. D., Hamstra S. J., Anastakis .D J., “Teaching technical skills: training on a simple, inexpensive, and portable model,” Plastic and Reconstructive Surgery 2002; 109(1):258-63; Zabaneh G., Lederer R., Grosvenor A., Wilkes G., “Rhinoplasty: a hands-on training module,” Plastic and Reconstructive Surgery 2009; 124(3):952-4). Physical models often tend to be basic, lacking complexity (Sheckter C. C., Kane J. T., Minneti M., Garner W., Sullivan M., Talving P., et al., “Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience,” J. Surg. Educ. 2013; 70(4):466-74). Computer models may aid in understanding anatomy and provide decision-making drills, however, they tend not to provide the technical skill gained from practicing within a physical workspace. As such, cadaver or animal models are usually used to learn plastic surgery procedures outside of the operating room (Sheckter C. C., Kane J. T., Minneti M., Garner W., Sullivan M., Talving P., et al., “Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience,” J. Surg. Educ. 2013; 70(4):466-74). However, with respect to cleft palate and cleft lip repair surgery, cadaver models tend to be virtually non-existent and animal models tend to be inaccessible.
Trans-oral surgeries, such as cleft palate repair, tend to be technically demanding procedures that require delicate tissue handling and dissection within a confined space with reduced access and visualization (Vadodaria S., Watkin N., Thiessen F., Ponniah A., “The first cleft palate simulator,” Plastic and Reconstructive Surgery 2007; 120(1):259-61). As a result, surgeries such as cleft palate repair tend to be challenging procedures to learn with limited teaching opportunities.
Cleft palate simulators have been developed to augment operating room experience (Vadodaria S., Watkin N., Thiessen F., Ponniah A., “The first cleft palate simulator,” Plastic and Reconstructive Surgery 2007; 120(1):259-61; Senturk S., “The simplest cleft palate simulator,” The Journal of Craniofacial Surgery 2013; 24(3):1056; Nagy K., Mommaerts M. Y., “Advanced s(t)imulator for cleft palate repair techniques,” The Cleft Palate Craniofacial Journal: official publication of the American Cleft Palate-Craniofacial Association 2009; 46(1):1-5; Matthews M. S., “A teaching device for Furlow palatoplasty,” The Cleft palate-craniofacial journal: official publication of the American Cleft Palate-Craniofacial Association 1999; 36(1):64-6). However, they tend to be highly simplified and are of limited value as teaching tools.